Adverse childhood experiences (ACEs) occur in a significant proportion of the population, with many unaware they may have an event in their past which can be classified as an ACE. Multiple ACEs increase the likelihood of developing a dependence on drugs and alcohol.
ACEs are defined as an event during early development that has caused some type of lasting trauma. These typically include physical, emotional and/or sexual abuse, neglect, living with a family member who is dependent on drugs and/or alcohol, living with a family member who suffers from mental illness, divorce and living with domestic violence. More recently, experiencing racism, witnessing a violent event, homelessness, involvement in the criminal justice system and involvement in the foster care system have been included as ACEs.
Compared to people who have zero ACEs, those with an ACE score are two to four times more likely to use alcohol and drugs. An ACE score of 5 or more (i.e., experiencing five or more traumatic events) sees an individual seven to 10 times more likely to use - particularly inject - illegal drugs and develop a dependence on them.
Dr Daniel Sumrok, director of the University of Tennessee’s Centre for Addiction Studies, believes addressing ACEs is an essential part of any drug treatment. In this article , he explains that he first began to notice the nexus between trauma and harmful drug use when researching the symptoms of Vietnam veterans living with PTSD. Later, he noted that of the 1,200 drug-dependent patients he had seen, more than 1,100 have an ACE score of 3+.
He also found that the plasticity of the brain means that, with the right moulding, it can be taught to better cope with memories of past trauma and the everyday incidents that can trigger them. This is part of resistance research, which involves addressing ACEs and implementing resilience-building practices into relevant bodies such as the family court system and schools.
Sumrok’s aim is to help his patients understand how their brains respond to instances of trauma, and that they are using drugs to cope in the absence of a healthy alternative. As part of his analysis of the relationship between an individual’s ACE score and the way they respond to treatment, he encourages group therapy and participation to better find out different patients’ attitude to treatment options available, how accessible those options are, and whether the individual feels comfortable accessing them in the first place. His approach has been praised by psychiatrists and others in addiction medicine as essential in determining the most effective treatment models for patients.
The underlying message is that patients need to be treated as equal players in their treatment options, and that often the patient will know what they best respond to. As one psychiatry expert put it - “Some of us [in addiction medicine] have come to understand that there’s more expertise in the community and our patients than we’ve understood”.